At the end of February we published the Wellthcare Manifesto. Having a Manifesto is probably grandiose, if not self-inflating and vulgar, but we wanted to bring our thinking together into a brief, easy-to-read, and hopefully powerful, statement.

At first we thought about publishing a ‘framework’ – the things you need to do to create Wellth – health-related value that sits latent in our networks, communities and contexts. However, we soon realised that we don’t yet know what you need to do. Indeed, just trying to answer that question made us realise that Wellthcare is not about knowing but about exploring – discovering what courageous people are doing on the frontlines, giving them a voice and then trying to find common themes that will embolden others to try.

In a way, the Manifesto acts as the guiding principles for the exploration. It acknowledges the importance of health care and prevention while pointing out their natural limitations. It tries to encourage us to think in new ways, especially when it comes to evaluating (and hence being able to value) ways to create health. And it makes the case that health care organisations cannot just keep telling people what to do (“top down”); nor can we expect communities to become health experts (“bottom up”); so we need to find new, collaborative approaches (“middle out” – a phrase I have stolen from John Vu of Kaiser Permanente, as described in this post).

People joining Wellthcare

Writing the framework-cum-Manifesto also helped us to better understand what we are doing. Sticking with the grandiose, Wellthcare has become a movement. Although modest, the steady rise in people signing up for the newsletter, following us on Twitter, and agreeing to be interviewed supports this. We don’t know if it’s a social movement or some other kind of movement, we just know that everywhere we go people are agreeing that we need to both work out what ‘health creation’ is and develop a deeper understanding of communities so they can activate their latent ability to care for each other. For the time being, the only way to ‘join’ the movement is to sign up to receive the Pioneer’s Log by email (the 'newsletter') or follow us on Twitter. Perhaps you can tell us what else we should be doing if Wellthcare is to continue to grow. The Manifesto hopefully also makes clear that we don’t see health creation coming about by just sitting in our institutions pondering. There’s way too much of that going on already, as evidenced by the 24,000 biomedical journals in the world, most of which are full of poorly conducted research with indefensible conclusions (their only saving grace being that no one actually reads them). We have to get into the business of ‘doing’, and in so doing find new ways of thinking. Will a Manifesto help to make health creation a reality? We don’t know. We just hope that people read it, perhaps share the PDF, think about it, discuss it with their friends and colleagues, and then either get into the business of doing or joining us – or both. It’s so abundantly clear that health creation has to become a reality. If you’re reading this, you’re as responsible as anyone else. So join us, let’s work out how to make it happen.

Whenever I need to be refocused I shall read your manifesto. Thank You

pritpal@wellthcare.com

5/3/2014 09:15:58 am

Thanks, Joe. Keep up the good fight!

Clive Pinder

6/3/2014 05:55:42 am

There isn't anything in the manifesto that any balanced person with a passion for improving healthcare would disagree with. So what is missing? I would like to see some accountable objectives so Wellthcare can differentiate itself from the myriad or well-meaning and well-funded think tanks that contribute to the debate but deliver very little in terms of 'making the change'. How will you/we know that you are making a difference, rather than just making a noise?

Pritpal S Tamber

6/3/2014 08:52:45 am

Dear Clive,

That's an excellent question and one that I am considering as I travel the US and Canada speaking with leading thinkers and doers in this space (with the kind assistance of Guy's and St Thomas' Charity).

My thinking is that Wellthcare is best honed to: "health creation through communities". Both parts - "health creation" and "through communities" impact evaluation.

First of all, we have few proven ways to measure the creation of health. We know how to measure sickness, or the avoidance of it, but not the creation of health. This requires new thinking that moves beyond the deficit model of health care.

Secondly, when working "through communities" we need to embrace the unpredictability of people and communities. This means understanding complexity - or at least working with it. Again, this is a new space for most people but one that needs to be embraced.

It seems to me that finding new ways to evaluate - and hence value - health creation through communities is the rate-limiting step to unleashing new forms of health-related value. This is the lock for which we need to find the key.

Or enough of a key to embolden people to experiment.

P

Clive Pinder

6/3/2014 09:41:17 am

Apologies Pritpal, I should have been a little clearer. I was referring to the Wellthcare organisation itself when I challenged you to commit to some outcomes, rather than how you measure Wellthcare in general society. How will we know if the time, energy, talent and funding invested in 'Wellthcare' the organisation is paying dividends beyond being a stimulating ideas forum?

pritpal@wellthcare.com

6/3/2014 02:13:55 pm

Thanks for the clarification, Clive.

First and foremost, I think there is significant value in there being a space for new ideas. If you spend time on the "health care circuit" you'll know - and I know you do - that there are very few new ideas at the table. I think we sorely need new ideas, new approaches, and a little bravery to try new things.

In terms of Wellthcare's plans I'd like to take it step by step, like a start up looking for its niche. For the time being the plan is to see if there is some kind of event to be had to bring thinking and doing together on how people are creating health through communities. There may be and there may not be. If it's the latter, the idea is to work out what other next step is needed. This is what the grant from Guy's and St Thomas' is enabling.

Overall, our intention is to create a "permission space", an environment where communities can try things and report back on what worked and what didn't work. Our hope is that it emboldens others to try, to experiment, to find ways to care without relying solely on provided services.

Although it'll be hard to directly value this, that does not mean that we're not thinking about trying. If you have any suggestions we'd welcome them.

As a clinician and technologist who works to use technology to create health as a means to improve reproductive outcomes, I wonder if Welthcare can be also quantified by metrics that reflect improved quality of life, while subjective, there are tools that measure a wide range of social outcomes such as outlook, happiness, optimism. Can we use the quantified self to draw tie health (Welth) to quality of life, and thus even potential for societial contribution?

Just waxing here, but I must say that I am so very inspired by your work! Thank you. Kirsten

Pritpal S Tamber

12/4/2014 05:14:18 pm

Dear Kirsten,

Thank you for your comment.

This is something I have been thinking about for a few weeks now. I think there are new metrics and forms of evaluation that could be used but their generic nature worries me somewhat. I think that before we decide what tools to use we should first *truly* understand what people value.

Health care has evolved into a supply-defined industry. To be sustainable it needs to become a demand-based one. In so doing, it's going to have to become answerable to its users, whether they be clients, tax-paying citizens and/or patients.

Two relatively noisy movements worry me in that regard.

The 'value' movement has decided that it can define outcomes per condition and then measure clinical performance against it. However, I see very little real evidence of asking patients what they value - which is not always full health.

I also think there is an emerging 'creating health' industry, which I love, but it's rather falling into the trap of deciding what people want. I think this makes this new health industry supply-informed - just like the current one.

What I think we need is a moment to step back, to see the need for what it really is, and then discuss what the right metrics are. I'm not convinced they're the stuff being developed in academic institutions all around the world.

I think 'the people' know what success looks like, and it's high time we asked them straight - even if we don't like the answers.

Just some more waxing here!

P

Clive

14/4/2014 06:36:58 pm

I agree that until we ask the people paying for 'wellthcare' "what success looks like", we wont be solving the problem. However, part of that definition has to include what they are prepared to pay for. To do that we need to know what things cost and what outcomes they produce. By outcomes I include quality of life, effort/pain involved etc, In the UK we have no debate about either because of an altruistic but misguided lobby that believes the minute you stop talking about 'free' and introduce cost or accountability you are calling for the end of the sacred cow - the NHS. Any wellthcare manifesto has to include a conjoint analysis of value defined by cost and value in their widest terms. If it doesn't, the people it serves (us) will never be able to make an informed decision on whether we can afford it... or not.

Pritpal S Tamber

29/4/2014 05:48:32 am

Dear Clive,

Thanks for this added comment, all of which I agree with.

I think the challenge for now, though, is to start debating what it actually *means* to create health through community. Going with the idea that communities need to decide what's right for them, it means we'll have plural definitions of success. This is something we need to 'manage' as we work towards finding alternatives to health care.

It's a big topic and not one that I think I can answer alone. As well as have the Wellthcare Explorers to debate this through with, I am working towards building an 'institute' or 'meeting' through which we can better define the challenge, the possible solutions, and the possible ways to evaluate (and value) it all. It's not something that will happen overnight.

You'll see that I propose this in my last post:
http://www.wellthcare.com/1/post/2014/04/creating-a-parallel-system-to-health-care1.html

Indeed, it was writing that post - including reflecting on the thoughts of Oliver and Kedar, that enabled me to see a way forward, and respond to your comment.